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Where did that bruise come from? Factors that influence our perception of pain.

We have all experienced pain, from our first skinned knee to anyone who unfortunately experiences pain chronically. Pain is one of the most common reasons for doctor visits, with health care costs due to pain ranging from $261 to $300 billion annually. If loss of work and wages are included the costs balloon to $635 billion. If we can gain a better understanding of pain and how to manage it, we can hopefully decrease the human and economic costs of all these aches and pains.

In the past it was thought that if you damaged your body, broke a bone, tore a ligament, or cut your skin, that damage would cause pain. Modern pain scientists have found this to be resoundingly false. You yourself have probably disproved this old way of thinking many times in your life. We can all remember that mysterious bruise, scrape or cut we find on our body but have no idea how it got there. There was obviously damage, look at the cut, but how did you not feel it?

In this FitBliss blog we will discuss how research has continued to find mounting evidence of damage occurring yet no perception of pain. Many of us have probably heard about soldiers walking miles with broken limbs, ERs filled with knife impaled yet serene patients, or athletes being oblivious to the blood streaming down their leg from a gash that the brain decided was unimportant. Conversely, making things a bit more interesting, there are also those who experience debilitating pain yet have no structural damage. How do these two phenomena occur? Scientists have been hard at work figuring out how sometimes we are able to ignore injury, and what dictates whether we feel pain or not.

Researchers have discovered that pain sensation is a multi-factorial process. They have found that when assessing pain it needs to be analyzed by using what they call the biopsychosocial model. Luckily the term is fairly self explanatory. Your biology, psychology, and the environment and/or social context all play a role in the outcome of whether you feel pain or not.

FitTip: Just got out of a stressful meeting and your back is speaking to you? Stop and take a deep breath. Then for two minutes try to slow down your breath. Try to start with a four second inhale, and a four second exhale. For the second minute try to breath in for four seconds, and out for five to six seconds, whatever feels comfortable. Breathing at this slower rate and emphasizing the exhale taps into your parasympathetic nervous system (rest and digest side of things) and has been shown to boost tolerance to the possible pain message coming from your body.

One of the factors dictating the pain message is the external input of your social and physicalenvironment. If you are that athlete mentioned above and receive a gash during a game, the wound is only one bit of information that enters the brain. There are loads of external stimuli coming in, such as the opponent chasing you, crowds cheering your name, or a cute fan in the bleachers. Think back yourself, you may remember if you were an athlete running down the field, the overwhelming rush as your peers cheered you on, and the social expectation of your strength and invincibility. With all of these distracting elements in your environment you wouldn’t notice if three opponents took you out, much less a gash on your leg.

Surprisingly, in a regular office job, which is a totally different type of environment than a soccer field, there are still external stimuli affecting your body. In this case, you can get lost in your work and become oblivious to the needs of your body. You can sit engrossed and frozen in one position unaware of the fact that your body may be stiff or in pain. The external inputs at work can be a looming deadline, a complex task, an aggressive boss, or the fact that everyone around you is also stuck motionless at their keyboard. You can end up disregarding your body’s sensations and its’ need to move around, rest, or even get food.

FitTip: Try to set a timer or be cognizant of the time and try to move and change position at least every 20 minutes, especially if you tend to be someone who gets deep in thought and frozen in one position. Try to get into the habit of moving and wiggling a bit more while you work.

No one posture is “bad” per se, the problems arise if you sit still in only one position. It’s OK to be hunched over (I know this is contrary to what many ergonomic specialists have told you), just don’t stay in that posture for too long. You can be hunched, but in five minutes try to sit back in your chair, then stand up and stretch around a bit, even go on the floor if possible. Laptops can be good to work with because they allow you to move a lot more. You can also get what are called Dyna discs. Put the disc in your seat, and it inherently will make you wiggle and move a bit more while you work (great for low back issues). This generally more active and mobile way of working will be key in keeping those nagging parts of your body quiet.

A second contributing factor of processing pain is your internal environment, or your specific biology. In the game example you can have endorphins pumping through your body. In the office atmosphere adrenaline may be present due to an imminent deadline. This internal chemistry will help in inhibiting any sensation of pain. Although long term exposure to stress ends up having the opposite effect and decreases our tolerance to pain.

Next, there is the brain and your psychology’s influence on the calculation of what we feel. Think back to that athlete, but now their history includes a difficult season ending injury that they had a year ago. Now they’re playing, and all of a sudden they get that gash and it feels strikingly similar to that old injury.

In this case the negative past experience of that old injury was cataloged in their brain. It sat vigilant ready to go on high alert if that feeling came again, a bit like an overprotective parent. The old wound and all the frustration and anguish that came along with it was stored away in their psyche that created a paranoid and excessive reaction to the present minor gash. This cascade reaction can send false pain signals and makes them unable to finish the game and possibly in the worst case turn into a chronic condition.

In these examples the same injury is occurring, but because of the multiplicity of factors that dictate how we react to stimuli, you get two opposing outcomes to the same injury. If we have awareness of all of these factors creating our pain outcome, we can hopefully better control and influence our pain sensation and response.

BIOLOGY STRIKES AGAIN

Say the minor gash in the second example did turn in to chronic pain. The presence of such chronic pain can affect one of our brains’ pain processing areas called the amygdala. This area can grow in size which increases the likelihood of sensing danger and threat even when there is none. Luckily, just as this area grew and because the brain is plastic, these folks can work to decrease the area using some of the methods outlined below, and hence calm the overprotective and worrisome parent part of our brain.

FitTip: Our psychology and outlook have a good bit of influence in how we process pain. Pay attention to your language and thoughts. Try to use less weighted words and thoughts when considering your pain. Instead of its ‘killing me’, ‘jacked up’, ‘it’s totally wrecked’, or ‘messed up’, try to instead use language such as your body part is ‘speaking to you’, ‘feeling relevant’, or ‘sending me a signal’. Try to see a path to getting it better, make a plan, get help, and take actions to get yourself better. This way of thinking helps stave off rumination that can also exacerbate pain sensation.

Researchers are constantly unlocking the mysteries of how we process pain and finding out all the different influences. Odd factors like looking at the color red increases the message of pain, unless your favorite home team color happens to be red then the effect is diminished. Who knew? A simple expectation of pain, or knowing that something might be painful can increase the sensation. Think of the needle your doctor holds before you. If you had no idea or expectation what a needle felt like it might not hurt as much.

Conversely, consider a martial arts fighter who has become habituated, accepting, and tolerant to the strikes and blows they receive. Even a hit, which usually is registered as a threat to the body, their brain decides to not perceive it as such and does not recognize the onslaught as painful.

Factors that affect your pain tolerance:

1) Perceived stress level (When stress is high, tolerance to pain decreases.)2) Sleep quality (Good sleep equals less pain sensation.)3) Compromised immune system (How tolerant are you when you’re sick?)4) Inflammation at the injury site and systemically5) History of injury and chronic pain (There are brain changes with chronic pain that over-sensitize sensation.)6) Expectation of pain heightens pain sensation

7) General level of fitness (Exercise cures all again! The more fit you are the more tolerant you are. Do Marie Kondo style and find any movement that brings you joy be it ballroom dancing, running, or hula hoop, and do more of that.)

IN GENERAL:

To increase tolerance to pain simply be mindful of the list above. If you live with boatloads of stress try to balance it out by upping your amount of self-care and coping techniques to decrease the maladaptive reactions to stress. These include exercise, meditation, breath work, massage, yoga, or whatever activity that calms your nervous system, do that! If you find yourself not rested after eight hours of sleep get a sleep study to ensure you are getting good quality restorative sleep. These can all help to increase your tolerance to painful events. If you do find yourself in pain it is a good idea to stay calm and be proactive using the tools listed above to work towards alleviating the pain. Make your pain relieving plan realistic as it’s much more likely to get done. To make it happen, you have to set aside time in your day for the different modes of self care suggested above.

Source: The Sports Physio, Adam Meakins

This article touches on some of the aspects of pain and how it works. If you want to learn more on the subject of pain check out: Greg Lehman, Lorrimer Moseley, David Butler, and the NOI group.

Catherine Cowey M.A. is a personal trainer and post-rehabilitation expert working for over twenty years in the Bay Area. She teaches workshops and is a contributing writer for several fitness websites. You can find out more on her website www.fitwizesf.com.